Insider Interview: PPE Shortage Affects Everyone

Previously, CareStitch’s Dr. Shelley Ackerman PT, DPT spoke with a home health clinician from Detroit about their experiences working during the COVID-19 pandemic. As challenges for U.S. healthcare systems endure, many professionals are working day and night to meet patients’ needs.  

In our next discussion we speak with another home health clinician about her experiences on the frontlines. Today, we are joined by an Occupational Therapist who has devoted this time to advocate for vulnerable seniors.  She is based in Florida and has worked in this field for 11 years. Read about the challenges that are in place as agencies and clinicians problem solve in a challenging environment to care for individuals and seniors who do not have adequate support from the local communities, state and system.  

SHELLEY: What has been your experience so far working through the coronavirus pandemic and has COVID19 changed the way you provide in-home care?

CLINICIAN: Yes, sadly it has and my experience has been very disappointing. I do a lot of contracting work as an independent contractor. I have a lot of family in healthcare. So initially, I felt that I just kind of assumed that safety was first.  It’s been very disappointing because from a safety perspective and emergency preparedness, the basic things that we would do to make sure that all of the clinicians are all on the same page and are keeping our patients safe just didn’t feel like that was at the forefront.  It could be just the individual home health companies I’m working with. So it’s been frustrating. I tried to reach out to the owner of the company when all of this started, I believe it was the first week of March, and questioned if there was a system in place or in the works.  When I asked, there wasn’t anything in place yet.  I volunteered and offered to come up with a resource page to help all the other clinicians. Or perhaps do a weekly coordination call, just something to provide to clinicians so they are not going in to work blindly and we are all on the same page.   But instead they thanked me for the offer and that they’d reach out if need be.  Unfortunately, it was business as usual, and that was scary.  

SHELLEY: Have there been enough PPE supplies or are those running dry?

CLINICIAN:  As a contract therapist, I got in the habit of purchasing additional supplies for myself although the companies would always provide supplies. I had used up all of my supplies I had and then realized that the companies also did not have enough to hand out. 

Those were my initial worries because I also know the other clinicians are relying on the office more than I do. And you know, when you are given 10 little sanitizers and alcohol wipes to use knowing there are no supplies locally. Throughout the first week, I had been masking with my own supplies, but the companies didn’t have any more masks.

It just felt very scary especially because I couldn’t justify inadvertently hurting my patients. So, I made the hard decision to not see any more patients.  The last visit I saw was on the 19th of March because I just could not be at peace with not knowing much about this virus.   So I think that the first part was just understanding how the virus is transmitted and knowing that I should be using transmission precautions.  This is when I decided I don’t feel I have the right equipment. I just didn’t feel like I could provide care safely.  

SHELLEY: When your PPE supplies ran out, is this when you decided, Ok, I can’t safely provide care anymore?   

CLINICIAN:  My decision happened progressively.  On March 20th I was waiting for a shipment of supplies I had ordered, it was a Friday.  That weekend a testing site opened up in the area that I live in for healthcare workers. So I decided to go get tested. Since at that point I was treating several patients who have been going to the VA and doctor’s appointment. I truly felt business was happening just as usual in the area I live in.  Waiting the seven day period after getting tested is what gave me time to really process.   I felt that the guidelines of best practice were very loosely defined and they were very fluid that the risks just outweighed the benefits.   

I had contacted my company to let them know on the 24th, I got tested.  I requested my employer to set up some kind of online platform for telehealth so that we’re not contacting every patient.  The response was the same as before, that they’ll let me know when they would be ready for that if they were going to implement it. 

The company I worked for were making us do drive-bys to pick up equipment in the parking lot or the main lobby — they were not letting us into the office.  I just thought, we can’t go into the office but they were OK with us going into the patient’s homes.  It just felt like a disconnect or a gap.  Us clinicians were not truly being considered for by the agency.

I feel like we could have been using the few full PPE’s that we had for the patients that were more critical and perhaps had only one clinician entering that home until we got more PPE.  There’s a balance between taking care of the patient and also making sure the patient is safe, I don’t feel like there has been any balance.

SHELLEY: What was your experience when you went to the testing site on March 25th?  What was going through your mind when you were in quarantine for 7 days waiting for your results?  

CLINICIAN: The federal testing center here is a drive through. They treat everyone like they’re exposed. That was an eyeopener for me.  I thought to myself, this is how we as home health clinicians should be treating all of our patients with full personal protective equipment. They don’t let you open your windows. You had to bring your own pen and show your ID through the glass where they could read it.  There were two groups of people in different lines at this testing site.  One line was for healthcare providers who did not have to show any symptoms and were able to get tested, and the other line was for people with symptoms.   I went early in the day and it was only a 2 hour wait. 

It really painted a picture of how we should be treating this situation.  It made it apparent that I have no business seeing my patients if I don’t have full PPE.  I used to work at a hospital, in the inpatient rehab department, and we were taught infection control and it’s not what we were doing or the discussions that we’re having at the companies I worked for.

SHELLEY: Well, what were you feeling at that time when you were in the car? What were the thoughts that were going through your head? 

CLINICIAN: My thoughts were that if I ended up being positive, this will be difficult to reconcile if I did not knowingly end up passing the virus to one of my patients because I’m healthy and feel I could weather this, but my patient demographic probably could not.  I would feel so guilty.  So I just had a lot of reflection to do afterwards. 

SHELLEY: Coronavirus has been scary for a lot of the population, what’s something positive that you feel like has come out of all of this, either for you or your patients?

CLINICIAN: I feel like our state has failed us with providing support for seniors in the community. The seniors in the community often very much rely on guidance provided by governmental services and there’s nowhere to seek that information. The few good things that may come of it is maybe a bit of innovation in how to provide support for seniors. I think for me it’s made me use my time into trying to see how I can go out and serve my community.

SHELLEY: Are you a believer in telehealth as an Occupational Therapist? 

CLINICIAN: I think it has a place, I think [for] my non-critical patients, we could monitor them with some form of telehealth. I think there are ways we could do it so we can minimize the exposure to those more vulnerable patients.

Patient safety is always at the top of the minds of home health clinicians. More so now during the pandemic and not having enough supplies, clinicians’ concerns are amplified. This brave clinician made the tough choice to stop treating patients and get tested. Luckily, for her and her patients, her results were negative. This is the reality home health clinicians are living and working in every day, with worries of the safety for themselves and patients. It is during these difficult times that the industry can learn from these experiences and continue to innovate to improve patient care and patient safety.